Dear Dr. Neimeyer,
My daughter killed a young man when her car ran into his motorcycle. It was determined that the accident was not her fault. Nevertheless, she was so bereaved that we had to take her to a Critical Care facility. How does someone grieve for someone they don’t know? How does someone recover from being responsible for killing someone, not intentionally?
Unfortunately, as your description of your daughter’s reaction to this tragic illustrates, being faultless does not protect us from the traumatic effects of horrific death, particularly when, even through no fault of our own, we were implicated in it. Nor are fatal accidents of the kind you describe the only instance of this anguishing reality, as guilt and trauma commonly attend other violent deaths as well, such as those resulting from suicide. There as well, innocence in a legal sense rarely shields survivors from the punishing emotional consequences that can follow.
However, it is important not to mistake your daughter’s response for bereavement, per se, as grief, in the sense of yearning for or experiencing deep loneliness for another is far less likely to feature in her emotional reaction to the accident than other equally profound responses, such as corrosive self-blame, persistent rumination about the accident punctuated by attempts to avoid reminders of it, and visual, auditory and perhaps somatic flashbacks to the accident, in which she relives it in uninvited intrusive memories, or is frequented by related images and emotions in nightmares and night terrors. No amount of well intentioned rational counterargument is likely to dislodge such symptoms, nor are attempts to suppress them likely to be successful; research indicates that such attempts can actually have a “boomerang” effect, and lead to their coming back all the more forcefully. This toxic blend of what is now understood as “moral injury” (witnessing or participating in an act, like killing, that assaults our sense of core values) and trauma (struggling with images, anxiety and hyper-vigilance associated with the scene of the death) requires different, and stronger “medicine.”
What form would this take? Likely it would require a trauma-informed approach to therapy, in which a specialized therapist would safely walk your daughter through a prolonged recounting of the trauma narrative, either in an extended slow-motion retelling, or in multiple briefer ones. The goal of this would be to develop more emotional mastery of the tragic circumstances in all their troubling detail, mindfully reviewing the experience scene by scene with the therapist’s support for staying with and gradually modulating spikes of negative emotion (meaning to hold the image until the feeling begins to dial down). There are many different procedures for accomplishing this, some of which use specific breathing methods, self-instructions, therapist stimulation or prompts for making meaning of the chaos of imagery and emotion, but all involve drawing close to the troubling experience under conditions of safety. Sometimes these can be followed by healing actions (in the form of making amends in some fashion with survivors of the deceased) or rituals (such as seeking forgiveness from oneself, from another, or from God). The important point is that the specific symptoms or emotions experienced by your daughter will help an expert therapist determine what she most needs, as she strives to move through this awful accident, learn from it what she can, and attempt to live fully and compassionately in an imperfect world in which we have less control over outcomes than we often wish.